A new generation of trade policy: potential risks to diet-related health from the trans pacific partnership agreement

Trade agreements pose a major risk for food insecurity and nutrition-related disease [1‐3]. The suite of multilateral trade agreements initiated by the World Trade Organization (WTO) and subsequently deepened through an increasing number of bilateral and regional trade agreements (RTAs), have brought about three important changes to food systems: opening of domestic markets towards international food trade and foreign direct investment (liberalisation); subsequent increased entry of transnational food companies and their global market (integration), and global food advertising (cultural hybridization). These three changes affect population diets, and raise concerns about undernutrition, obesity and non-communicable diseases, by altering the local availability, nutritional quality, price and desirability of foods [2, 4, 5].

This paper aims to alert policy-makers, researchers and non-government organisations to the potential harmful impacts of new forms of free trade agreements, exemplified by the Trans Pacific Partnership (TPP) agreement, on nutrition and diet-related health. The TPP has been under negotiation since 2010, and involves Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the USA and Vietnam [6], with more likely to accede over time.

A radical new generation of RTAs are emerging in the 21st century, extending the scope and reach of trade agreements. In theory, trade liberalisation - the reduction in barriers to trade - can improve economic growth through increased export opportunities to overseas markets, attraction of foreign investment into countries and lower cost imported goods [7]. Trade-generated income can potentially benefit population health and nutrition by improving access to healthcare, labour standards and quality and quantity of food [8‐10]. However, trade liberalisation is known to create winners and losers between and within countries [11‐15]; with the ‘trickle down’ social and health benefits depending partly on the progressivity of a country’s regulatory and redistributive policies [16]. Trade is no longer simply about the exchange of raw materials and final goods between countries. It has evolved into a complex “trade-investment-service nexus”, involving integrated flows of goods, services, people, ideas, and investments in physical, human and knowledge capital [17]. These developments affect policymakers’ control over regulating their economies and have implications for how the theorised benefits of liberalised trade are distributed, but importantly can also affect the policy space governments have for health or social purposes [18]. Multilateral trade is governed by rules set through the World Trade Organisation (WTO) [19]. As the returns for high income countries from multilateral trade decreased over time, with stalemates between countries in the multilateral Doha development agenda, and the economic power balance shifted between countries and regions, increasing numbers of regional trade agreements (RTAs) and bilateral investment treaties emerged, sitting outside the multilateral trading rules [17, 20]. All members of the WTO, when negotiating a trade agreement, must adhere to its rules on bilateral and regional trade agreements. Although the WTO’s “enabling clause” recognises that developing countries may need to protect some, or many, sectors of their economies from open competition with other countries’ exporters, the clause does not extend to regional trade agreements involving developed countries. The number and scope of RTAs are increasing rapidly [21]. The WTO’s analysis of the types of provisions of 97 RTAs globally found that four appear in over a third of RTAs, but which are not part of the WTO’s rulebook. These are competition policy, movement of capital, IPRs not in the multilateral TRIPs Agreement, and investment liberalisation. Known as the 1996 Singapore Issues, developing countries ruled these four issues off the agenda for the multilateral Doha Development Round. Since no agreement was reached to include these issues through the WTO, developed nations have pushed that any new bilateral or regional trade negotiations in which they enter must include these issues. None of these provisions are tariff-based, but instead are regulatory in nature, and their growth is “testimony to the growing importance of behind-the-border measures in RTAs” [17].

The TPP is an RTA unlike any of its predecessors [22]. It is a misnomer to call it a trade agreement: The TPP will be more like an investment treaty, designed to increase economic integration and arguably shifting the balance of policy-making power firmly in favour of corporate interests [23]. Whilst it would include traditional measures, based on what we know from leaked documents and public stakeholder consultations, the TPP appears to have unprecedented protections for investors and intellectual property rights holders [8]. Upon signing the agreement, changes to domestic policies are also likely to be required in relation to regulatory coherence, transparency, trade facilitation and harmonisation. These ‘behind-the-border’ regulatory controls on government increasingly limits policy space and national sovereignty to regulate investors or introduce public health policies that investors consider in contravention to the trade agreement [24‐26].

TPP negotiations are taking place under conditions of confidentiality. While the broad outlines of the TPP were announced at the Asia Pacific Economic Cooperation meeting in November 2011, analysis must rely on leaked documents including draft text leaked from the negotiations [publically available from a range of websites including http://​www.​citizen.​org; http://​tinyurl.​com/​tppinvestment; http://​www.​infojustice.​org/​archives/​category/​trade-agreements/​trans-pacificpartnersh​ip; http://​keionline.​org/​tpp], updates from trade departments [http://​www.​dfat.​gov.​au/​fta/​tpp/​index.​html], and the US Congressional Research Service reports available after every negotiation round [http://​fpc.​state.​gov/​c18185.​htm], and discussions with trade negotiators who have spoken publically through the stakeholder consultations about the broad form of the TPP. However, given the lack of available official information, and the ongoing nature of negotiations, this paper is necessarily exploratory in nature. First we review the evidence of the impact of existing trade agreements, particularly RTAs, on population nutrition globally. Informed by this, plus analysis of leaked information relating to the TPP, we hypothesise ways in which the TPP may pose risks to nutrition.

To investigate the relationships between existing trade agreements, nutrition and diet-related health, a literature search of a cross-disciplinary range of databases was undertaken, including: Science Direct, PubMed, ProQuest,SpringerLink, and Google Scholar. The grey literature was searched and reports from government and non-government organisations were used.

A conceptual overview of the relationship between trade, food and diet-related health is shown in Figure 1. The component parts of trade agreements are called ‘chapters’. In developing a trade agreement, the provisions are negotiated for each chapter. There are three major pathways through which trade agreements can affect nutrition, each of which is now discussed.

Based on the above analysis of existing trade agreements, and following assessment of government documents and draft text describing the likely provisions within the different TPP chapters, we now hypothesise ways in which the TPP could affect nutrition and health.

At the time of writing, there are twenty-nine TPP chapters under negotiation. The likely chapters with most relevance to nutrition-related health include: Market Access; Intellectual Property Rights (IPRs); Cross-border Services; Technical Barriers to Trade (TBT); Sanitary and Phytosanitary measures (SPS); Investment; and Dispute Resolution and Transparency (all of which have precedents in WTO agreements); and new chapters on Competition and State-owned Enterprises (SOEs); Regulatory Coherence; and Government Procurement (presently an optional agreement within the WTO).

In addition to the nutrition issues associated with existing FTAs, as raised in the previous section, the new health concerns with the TPP arise from the intensification of existing trade provisions and unprecedented protections for investors and intellectual property rights-holders [8]. Under WTO trade rules, any FTA must offer at a minimum the same WTO provisions. The only reason to include chapters on topics that already exist in WTO agreements into new trade agreements is to intensify them, requiring deeper liberalisation commitments or more extensive IP protection. A more novel concern is that the TPP appears to include various unprecedented provisions which would increase the privileges of TNCs and potentially reach much further into the regulation of domestic public policy that any previous FTA [48].

Prioritisation by the TPP of investors and the associated controls on policy-making would raise legitimate concerns for population nutrition. The TPP could include changes to domestic regulatory regimes facilitating greater industry input to policy processes and more avenues of appeal, more policy controls with implications for regulation of foreign investment in domestic food production and retailing, and extensive IPRs which could affect food labelling and advertising restrictions. The net effect of these changes would be to strengthen the influence of mainly western TNCs on government policy, and weaken public health’s ability to protect populations against unhealthy commodities. These risks and impacts will not be experienced equally between countries or social groups, thereby exacerbating nutrition and health inequities.

Due to the secrecy of the negotiations it is unclear if there are safeguards in place for diet-related health but there does not appear to be any systematic consideration of health concerns in the negotiations. Rebalancing the influence of food corporations in the TPP negotiation processes with input from the health sector is vital. Public health nutrition advocates and health-related policymakers must be proactive in their engagement with the trade negotiations to minimise negative outcomes and preserve policy space for population nutrition goals. A window of opportunity exists to integrate these concerns into the TPP while it remains under negotiation. Public health advocates could be contributing to stakeholder forums, meeting with trade officials, and lobbying Ministers for Health to engage with the trade negotiations. These short term interventions are not enough. Evidence to inform trade policy that embeds principles of health, nutrition and equity, and implementation strategies that mitigate the negative health consequences of the TPP and other trade agreements are needed.